Prostate cancer is one of the most common types of cancer in men, but it may be treated successfully if it’s detected early. It occurs in the prostate, a small gland producing the seminal fluid that nourishes and transports sperm. Risk factors for prostate cancer include older age, a family history of the disease, a poor diet (high fat, low fiber, no fresh fruit and vegetables) and high body mass index.
- Early stage – prostate cancer might cause no symptoms
- Advanced stage – prostate cancer usually causes signs and symptoms, such as:
- Frequent need to urinate, particularly at night
- Trouble starting and stopping stream of urine
- Not able to urinate standing-up
- Weak or interrupted stream of urine
- Blood in semen or urine
- Leaking of urine when coughing or laughing
- Discomfort in the pelvic area
- Erectile dysfunction
- Pain or burning during urination or ejaculation
- Deep pain or stiffness in the pelvis, lower back, ribs, or upper thighs
- Pain in the bones of the above areas
- Nausea, vomiting
- Weight loss
- Increasing shortness of breath
- Weakness or paralysis in the lower limbs
- Swelling of the lower extremities
It's unclear what causes prostate cancer. Urologists know that the cancer starts when some cells in the prostate become abnormal. Mutations in the abnormal cells' DNA result in cell growths. In addition, the cells divide faster than normal cells do. Those abnormal cells continue living, when other cells would die. The accumulating abnormal cells develop a tumor that may grow to invade close tissue. Some abnormal cells might break off and spread to other parts of the body.
The following factors may increase the risk of prostate cancer:
- Older age: The majority of cases of prostate cancer arise in men over 65. The disease is rare in men under 40 years of age.
- Family history of prostate or breast cancer: If men in the family have had prostate cancer, the risk might be increased. If there is a very strong family history of breast cancer, the risk of prostate cancer may also be higher.
- Obesity: Heavily overweight men diagnosed with prostate cancer might be more likely to have advanced disease that's more difficult to treat.
- Poor diet with lots of red meat, fatty food, and too little fruits and vegetables.
The disease, surgery (radical prostatectomy) or radiotherapy might lead to:
- Metastases: Prostate cancer may spread to nearby organs, e.g. bladder, or travel to the bones or other body parts. Prostate cancer that has spread to the bones can result in pain and broken bones. Once it has traveled to other areas, it's unlikely to be cured.
- Urinary incontinence: Treatment for incontinence depends on the type, degree of severity and likelihood of improvement in the long run. Treatment options are e.g. medications, catheters and surgery.
- Erectile dysfunction: Medications, vacuum devices that assist in achieving erection as well as surgery may treat erectile dysfunction.
If prostate cancer is only found in the prostate gland, it can be treated with very good chances for survival. That’s why urologists recommend that all men over the age of 40 get a preventive screening for prostate cancer once a year. It’s important to diagnose the growing tumor as long as it’s small, locally limited and doesn’t cause symptoms. In these early stages, the treatment and chances of recovery are the highest.
The treatment options depend on several factors:
- How fast the cancer is growing
- How much the prostate cancer has spread
- Overall health of the patient
- Benefits of treatment
- Potential side effects of treatment
For men with prostate cancer in a very early stage, treatment might not be necessary right away. Some men, actually, may never need treatment. Instead, urologists sometimes suggest active surveillance with regular follow-up blood tests, rectal exams and possibly biopsies to monitor progression of the cancer. In case the cancer is progressing, the affected person may opt for a prostate cancer treatment, e.g. surgery or radiation.
Active surveillance may be an option if the cancer:
- isn't causing symptoms
- is expected to grow very slowly
- is confined to a small area of the prostate
- treatment might be more difficult because the patient has
- another serious disease
- advanced age
Active surveillance also carries some risks, e.g. that it might grow and spread between checkups, and make it less likely to be cured.
Prostate cancer radiation therapy can occur in two ways:
- Radiation that comes from outside of the body: The patient lies on a table while a machine moves around his body, directing x-rays or protons to the prostate cancer. This kind of therapy usually takes place five days a week for several weeks.
- Radiation placed inside the body: Lots of radioactive seeds are placed in the prostate tissue. Those seeds deliver a low dose of radiation over a long period of time. They are implanted in the prostate by the doctor who uses a needle that is guided by ultrasound images. The seeds eventually stop giving off radiation and don't need to be removed.
Side effects: painful urination, frequent urination and urgent urination, loose stools, pain when passing stools, erectile dysfunction.
During surgery the prostate gland, some surrounding tissue and a few lymph nodes are removed. The radical prostatectomy procedure can be performed in the following ways:
- Using a robot to assist with operation: This allows the surgeon to make more-precise movements with surgical tools than it would be possible with traditional minimally invasive surgery.
- Making an incision in the abdomen: During retropubic surgery, the prostate gland is taken out through an incision in the lower abdomen (lower risk of nerve damage, problems with bladder control and erections).
- Making an incision between anus and scrotum: This results in quicker recovery times, but the technique makes it more difficult to remove the close lymph nodes and avoid nerve damage.
- Laparoscopic prostatectomy: The doctor performs surgery through small incisions in the abdomen with the assistance of a tiny camera. The surgeon has to be very skilled, and the nearby structures may be in danger to be cut.
This treatment is supposed to stop the body from producing the male hormone testosterone. Cutting off the supply of hormones might cause cancer cells to die or to grow more slowly. This therapy is applied in men with advanced prostate cancer in order to shrink the cancer and slow the growth of tumors. In men with prostate cancer in an early stage, hormone therapy might be used to shrink tumors before radiation therapy. This can help make radiation therapy more successful.
Hormone therapy options:
- Medications that stop the body from producing testosterone
- Medications that block testosterone from reaching cancer cells
- Surgery to remove the testicles to reduce testosterone level
Side effects: erectile dysfunction, hot flashes, loss of bone mass, reduced sex drive, weight gain
The drugs kill rapidly growing cells that include cancer cells. Chemotherapy is administered through a vein in the arm, in pill form or both. It may be a therapy option for men with prostate cancer that has spread to distant areas of their bodies. Chemotherapy might also be an option for cancers that don't respond to hormone treatment.
Immunotherapy uses the immune system to fight cancer cells. One type of biological therapy (“sipuleucel-T (Provenge)” treats advanced, recurrent prostate cancer. This therapy takes some of the patient’s own immune cells, genetically engineers them in a laboratory to fight prostate cancer, then injects the cells back into his body through a vein. A few men respond to immunotherapy with some improvement, but it requires multiple treatments.
Follow-up exams after treatment
Follow-up exams take place quarterly in the first two years, and are very important. Apart from the regular exams, it’s imperative to see a doctor if new bone pain or “rheumatic” complaints develop. In addition, complications and side effects of the therapy are treated. Medical doctors, psychologists and social workers may also take care of psychological and social problems that occur in some patients.
Reduce the risk of prostate cancer by:
- Choosing a healthy diet with lots of fresh fruits, vegetables and whole grains
- Avoiding high fat foods
- Exercising most days of the week
- Maintaining a healthy weight
- Discussing with your urologist the risks of prostate cancer